Key clinical and laboratory procedures have undergone a fundamental change as a result of new digital tools that facilitate data collection, team communication, computer-assisted diagnosis and treatment planning, as well as the design and fabrication of restorations, guides, stents, and devices in general.

To take advantage of these digital opportunities and provide all patients with their benefits, a straightforward, comprehensive digital workflow must be created. Making digital workflows the norm rather than the exception is critical for growing a dental practice in this new environment. This 6-step introduces a new comprehensive digital workflow that alters and improves the process of treating a comprehensive case, from diagnostics to execution and maintenance. 

Step 1. Patient Digitalization
Patient Digitalization has taken the place of traditional and analog patient documentation in the new fully digital process. A significantly more accurate analysis and visualization of all orofacial issues as well as functional, structural, and aesthetic aspects, including the temporomandibular joint (TMJ), airway, and other anatomical structures, are made possible by the integration of a 3D face scan with the CBCT scan, STL files, virtual articulator, and face and jaw movements.

With the use of artificial intelligence (AI) techniques, merging and overwriting of such files is getting noticeably easier. Digital process technologies that boost precision and accuracy are always evolving and may soon replace analog steps, such as taking into account interocclusal data, facebow registration and transfer, and mounting models in an articulator. 

Step 2. Cloud Data Management
The concept of Cloud Dentistry is another significant advantage of the entire digital workflow. The information can be quickly stored in the cloud with specially created software and in formats that are compliant with the local patient data privacy regulations because the patient is digitalized and all paperwork is available as digital files.

A system that enables “asynchronous communication,” or communicating with several persons who are neither in the same place nor available at the same time, is the answer to these problems. This idea comes from social media, where users can message multiple individuals at once. People are free to respond and interact whenever it suits them. Team members can still actively participate even if their schedules or locations do not coincide in time or place since it enables information sharing and exchange.

Step 3. 3D Treatment Simulations & Collective Intelligence
The next phase in the entire digital procedure is to use 3D simulations to explore the numerous options and possibilities. The purpose is to reduce actual errors by making mistakes on the computer. It is comparable to a pilot who practices several times before taking off in a real plane with real passengers.

The new fully digital workflow gives the dentist the chance to turn every treatment option suggested by the team into 3D simulations, either by having the dental office purchase and train staff on all necessary technology, or, in a more practical scenario, by outsourcing the workup to a planning center that converts suggested treatment plans and procedures into simulations, allowing any dentist to take a look. 

These simulations establish a cloud connection between the clinical treatment planning team and the planning center, which is only feasible if all patients have been converted to digital records. As a result, the three foundational components of the current digital workflow are connected in the following ways: patient digitalization —>  cloud dentistry/asynchronous communication —> virtual treatment simulation/outsourcing of planning centers.

Step 4. Patient 3D Presentation
The patient is given the treatment plan as the following step in the workflow. This next crucial step involves the patient after all concepts have been replicated and Asynchronous Communication has enabled the team to assess them and determine the optimum treatment approach. Technology has a significant impact on patient education and motivation. The easiest approach to communicate and persuade people to accept a concept is through visual means. The ability to use visual communication techniques to engage the patient, raise awareness, and eventually win case acceptance is crucial for the person presenting the treatment plan. All previous treatment simulations that were utilized to develop the treatment plan will now be incredibly effective at educating the patient. 

Step 5. Guided Dentistry and Step 6. Digital Quality Control
The differences between initial plans and final results are one of restorative dentistry’s biggest constraints, and digital dentistry is very useful in overcoming this problem. In the past, there were frequently significant variations between the results of an initial diagnostic wax-up and the ultimate treatment.

Additionally, they represented the rule rather than the exception. Analog protocols have been unable to overcome these limitations. Freehand intraoral procedures are expected to be phased out in the future, with all procedures utilizing some type of digitally designed guide or device. This is the idea behind Guided Dentistry. 

Before moving on to the next phase, all methods must also be reviewed by contrasting the results of the first simulation with those that were really obtained. Furthermore, before proceeding to the next step, all procedures must be evaluated by comparing the initial simulation to the achieved result. Discrepancies can be detected and corrective measures implemented by superimposing scans of the initial and actual situation. This is the idea behind Digital Quality Control.

Summary:
The new comprehensive digital workflow consists of six essential processes, including digital simulation, case acceptance, guided therapy, and digital quality control. It also includes cloud-based interdisciplinary treatment planning and digitalized patient information. A facially driven smile design and treatment plan are converted into a 3D project using the digitalized patient data. This project directs the development of a treatment “script” that specifies the precise order and timing of the procedures to be carried out. In order to lessen the differences between the plan, as approved by the dentist and the patient, and the final result, guidelines and gadgets are created. For quality control objectives, the final result and the circumstances during follow-up visits are scanned and overlaid with the initial simulation. Accordingly, adjustments or retreats can be made.

Source: The International Journal of Esthetic Dentistry, Volume 16, Number 1, Spring 2021